Effect of Protein Supplementation on Health-Related Quality of Life in Individuals With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: We performed a systematic review and meta-analysis to evaluate the effect of protein/amino acid supplementation on health-related quality of life (HRQOL) in advanced chronic kidney disease (CKD) including individuals on dialysis.

Methods: Medline, Cochrane Central, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched (establishment until August 2022) for randomized controlled trials evaluating the effect of protein or amino acid supplementation (>5 g/day) on individuals with advanced chronic kidney disease (estimated glomerular filtration rate <30 mL/min and/or on dialysis). Primary outcome was change in HRQOL. Secondary outcomes included biochemical, anthropometric measures, and physical function. Two reviewers independently screened articles for inclusion based on the prespecified criteria, extracted data, and assessed risk of bias. Meta-analysis was performed by pooling mean difference or standardized mean difference using a random effects model if at least three included studies reported our prespecified outcomes.

Results: Of 5,699 articles, 17 were included for analysis. We found no improvement in HRQOL in qualitative synthesis of four studies. Protein and/or amino acid supplementation was associated with an improvement in serum albumin (mean difference (MD) = 1.76 g/L, 95% confidence interval (CI) [0.67, 2.84], P = .002, I² = 88%) and body mass index (BMI) (mean difference = 0.29 kg/m², 95% confidence interval [0.10, 0.49], P = .004, I² = 0%), as compared with controls.

Conclusions: A small number of studies prevented meta-analysis for HRQOL. Statistically significant improvements in serum albumin and body mass index were observed with protein supplementation compared to controls. Small number of studies, high risk of bias, and heterogeneity of included studies support the need for rigorous clinical trials, investigating the effect of protein supplementation on patient-relevant outcomes.

Keywords: chronic kidney disease; dialysis; nutrition; protein; quality of life; systematic review.